Is the laparoscopic approach justified in patients with xanthogranulomatous pyelonephritis?

Objectives. Xanthogranulomatous pyelonephritis (XGP) is an atypical form of chronic renal infection, The treatment of choice is open nephrectomy, whic h is challenging, given the extent of the disease and the not uncommon invo lvement of the renal hilum and contiguous structures. We compared our exper ience with laparoscopic nephrectomy for histologically confirmed XGP with t he open approach. Methods. Review of all nephrectomy specimens at Washington University Schoo l of Medicine from July 1990 to March 1998 disclosed 9 patients with a path ologic diagnosis of unilateral XGP, of whom 5 patients underwent laparoscop ic nephrectomy and 4 underwent open nephrectomy. XCP was suspected preopera tively in 56% of the patients. Results. For the laparoscopic group, the average operating room time was 36 0 minutes, average blood loss was 260 mt, and complications occurred in 60% of patients (1 conversion to open, 1 ileus, 1 pulmonary embolus). For the open group, the average operating room time was 154 minutes, average blood loss was 438 mt, and there were no complications. Both groups were similar regarding time to oral intake, analgesia requirement, hospital stay, and ti me to complete recovery. Conclusions. Our early experience demonstrates that the benefits of laparos copic nephrectomy, at present, do not extend to patients with XGP. Conventi onal open surgery is quicker, associated with fewer complications, and resu lts in a similar use of analgesics, hospital stay, and recovery time. (C) 1 999, Elsevier Science Inc.